Midwifery Council competence reviews and complaints: a guide for midwives

Under the Health Practitioners Competence Assurance Act 2003 (HPCA Act), a concern about a midwife can start in several ways: a complaint from a woman or her whānau, a notification from another practitioner or an employer about competence (s 34), notice of a conviction, or a concern about a practitioner's health. Any employer, Health New Zealand | Te Whatu Ora included, that loses a midwife over competence, whether by dismissal or resignation, has to tell the Council.

When a woman or her whānau complain about your care, the Council's first step is to send the complaint to the Health and Disability Commissioner. HDC deals with it before the Council can, although interim protective steps remain open to the Council.

The Council then decides which pathway fits:

• Competence: is the midwife practising to the required standard? This can lead to a competence review.
• Conduct: has the midwife behaved in a way that may be professional misconduct? This goes to a Professional Conduct Committee.
• Health: is a physical or mental condition affecting practice? This follows the health provisions of the Act.

The same events can touch more than one pathway, and the Council's competence review booklet notes that serious concerns found during a review can be referred to the professional conduct or health processes.

A competence review under s 36 of the HPCA Act looks at whether you meet the standard of competence required for your scope. The Council's booklet "Your competence review" (2025) says reviews are "designed to be educative, supportive and to focus on assisting you to improve your standard of practice". It is not a disciplinary hearing and it does not decide guilt.

You receive written notice with Terms of Reference. These set out:

• why the review is being carried out;
• the particular areas of practice it will focus on;
• the assessment activities to be used and how the panel will report.

Read the Terms of Reference as your study guide. Everything the panel looks at should connect to them. If an area is described in a way you think is wrong or too broad, say so in writing early.

The panel is made up of registered midwives drawn from a pool kept by the Council. Members must meet set criteria, including current registration, clinical competence and good standing in the profession. They sign a confidentiality agreement, and the Council will not release details of the review without your consent except as needed for the review itself.

Before the panel meets

• You can suggest people the panel should speak to, such as colleagues who have seen your recent practice.
• You can make written submissions.
• A support person may come along. The booklet says this cannot be a student midwife.

During the review

• The panel meets with you at the start and as needed, face to face or by Zoom or Teams.
• You must make clinical records available for inspection.
• Interviews are not audio recorded by panel members, so take your own written notes or ask your support person to.

The OSCE

Where the Terms of Reference include it, the panel may use an Objective Structured Clinical Examination (OSCE): simulated scenarios that test your practice against the Council's standards. Treat it like any clinical assessment. Practise talking through your reasoning, your communication with the woman and your documentation, not only the technical steps.

The Council's booklet lists roles you must stop while you are under review:

• Midwifery Standards Review reviewer work and Resolutions contact roles;
• mentoring midwives in any capacity;
• locum practice;
• precepting students.

These limits continue until you have completed all competence orders, not just until the panel reports. If the review leads to a competence programme that runs for months, the restrictions run with it.

In practice this can affect income (locum work), team rosters (preceptorship) and professional roles you value. Tell anyone who relies on you for these roles early, so arrangements can be made without disclosing more than is needed. If you are unsure whether a particular role is caught, ask the Council in writing and keep the answer.

1. Notice and Terms of Reference from the Council.
2. Review activities: meetings, record review, interviews with people who know your work, and an OSCE if included.
3. Panel report within 20 working days of completing the review.
4. Your response: you are given 10 to 20 working days to make written comments on the report before the Council decides.
5. Council decision on whether you meet the standard and, if not, which orders to make.
6. Appeal: a suspension or restriction on your scope can be appealed to the District Court within 20 working days after notice of the decision.

The Council pays the panel's costs. You pay your own costs of taking part and of complying with any orders, which can include the cost of an education programme or supervision.

Use the response window well. Correct factual errors with evidence, acknowledge what the panel got right, and show what you have already done about it. A response that only argues tends to be less persuasive than one that shows learning underway.

If the panel finds you competent, no further action is needed. If not, the Council can make one or more orders under s 38 of the HPCA Act. The booklet lists:

• a competence programme;
• one or more conditions on your scope of practice;
• an examination or assessment;
• supervision of your practice by another midwife.

Where concerns are serious, the Council can suspend the midwife's practising certificate or send the matter on to the professional conduct or health processes. Section 39 also allows suspension or conditions part-way through a review where the Council thinks women or babies could come to serious harm.

Two other points in the Act matter. An unfinished competence programme can lead to a narrower scope or suspension, although s 43 stops it being treated as misconduct in itself. Section 44(4) also keeps what you say during the review or programme out of evidence against you and cannot be used for other purposes.

The content of a competence programme, and who supervises it, is set by the Council. An independent course can only form part of it if the Council accepts it.

Many concerns about midwives begin with a complaint to the HDC about maternity care. HDC assesses the complaint and may close it, refer it to you to resolve with help from the advocacy service, refer it to another agency such as the Council, make recommendations (an apology, service changes, education), or open a formal investigation.

• HDC's guidance for providers says to respond sensitively and aim for early resolution where you can. Supplying your account and maternity notes to HDC when asked does not breach privacy.
• In an investigation, you usually have 15 days to respond. HDC obtains independent clinical advice, sends a provisional opinion for comment, and then a final opinion with breach or no-breach findings.
• The final report goes to the Council, and HDC publishes anonymised reports online. For the most serious breaches, HDC's Director of Proceedings decides whether to prosecute the midwife in the Tribunal.

Read HDC's page "What if a complaint is made about me?" early. Published HDC decisions about midwives are also a useful way to see which parts of the Code of Rights come up in maternity care, especially Rights 4, 6 and 7.

Conduct concerns follow the same route for all professions under the HPCA Act. The Council refers the matter to a Professional Conduct Committee (PCC), usually two peers and a layperson. The PCC investigates and can recommend steps to the Council (for instance a review of competence, conditions, or counselling), propose conciliation, close the matter, or charge the midwife before the Health Practitioners Disciplinary Tribunal (HPDT).

The Tribunal decides charges of professional misconduct and has a range of penalties for a midwife: cancelling registration, suspending it or imposing conditions (each for three years at most), censure, a fine (NZ$30,000 maximum) and a costs order. Its decisions are published, and name suppression has to be applied for.

A competence review and a PCC are different processes with different purposes. You may face one, the other, or both. For a cross-profession explanation, see our Professional Conduct Committee guide and our overview of fitness to practise in New Zealand.

The Midwifery Council's Code of Conduct is the standard any panel or committee will hold your behaviour against. Some duties come up repeatedly in maternity concerns:

• Boundaries: midwives "must not become involved in a sexual or emotional relationship with a woman in their care"; the Code extends this to partners and family. Long continuity-of-care relationships make drift easier to miss.
• Information: women must get "impartial, honest and accurate information", and your own beliefs must not bias the advice.
• Maternity notes: written information should be "understandable, clear and professional" and avoid unnecessary jargon. Gaps in notes make it hard to show the care you actually gave.
• Colleagues: no malicious or unfounded criticism of colleagues; transfers of care depend on respectful handovers.
• Behaviour: do not bring the profession into disrepute, take care on social media, decline gifts that could compromise objectivity, and keep a workload that protects the quality of care.

1. Get advice first. Contact your professional body or union, your indemnity provider and, where needed, a lawyer before you send anything substantial.
2. Never alter records. If a note needs correcting, add a dated, signed late entry that is clearly marked as such.
3. Map the Terms of Reference against your own practice: the parts of your care that went well, the decisions you would now make differently, and the changes already in place.
4. Gather evidence of current practice: recent recertification records, MSR outcomes, emergency skills attendance and feedback.
5. Start targeted learning now, focused on the areas named, and reflect in writing on how it changes what you do.
6. Choose your support person and brief them on the process.
7. Look after yourself. Reviews take time. Keep up with your own health care and lean on trusted colleagues.

Learning you start before the panel reports can show that you have taken the concern seriously, provided it is targeted and backed by honest reflection. Our courses cover the professional side of midwifery concerns: documentation, consent and communication, boundaries, open disclosure, responding to a complaint and building insight. Every one ends with 20 assessment questions needing 80%, and gives you a certificate and a reflective account to bring to the review.

They have limits. A competence programme, conditions or supervision ordered by the Council are set and monitored by the Council, which decides what education is acceptable. Nothing we offer is approved by the Midwifery Council or able to replace a programme it or the Tribunal has ordered. If you are under an order, ask the Council, your supervisor or a lawyer whether a course would be accepted, and get the answer before you buy.

See how the courses work on our NZ course catalogue.